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My Book

In a recent post I made an obvious point. If our immune systems were stronger, we would need antibiotics less often and antibiotic resistance would become less of a problem. I hadn’t heard this point made (for example, this WHO report fails to say it). This was one example, I said, of how mainstream health care ignores the immune system. Perfectly obvious things, such as this idea about antibiotic resistance, fail to be noticed. I gave five more examples. Since then I have come across even more examples:

1. Hospitals do little to help patients sleep and often interrupt sleep, Nancy Lebovitz pointed out (better sleep –> better immune function). This article describes the problem. One way to improve hospital sleep — beyond don’t wake patients up — would be to provide exposure to strong sunlight-like light in the morning and prevent exposure to sunlight-like light after dark. I found that an hour of sunlight or similar light from fluorescent lamps in the morning improved my sleep. Most fluorescent light resembles sunlight (both have strong bluish components), incandescent light (reddish) does not. Until they install dual lighting systems (bluish light during the day, reddish light at night), hospitals can provide blue-blocker glasses to wear after dark.

2. The book Immortal Bird (sent me by the publisher) tells how Damon Weber, born with a defective heart, had a heart transplant when he was a teenager. After the transplant, problems arose. The doctors involved (at NewYork-Presbyterian ­Hospital/Columbia University Medical Center) took the problems to be signs of transplant rejection. In fact they were due to infection. Drugs given to deal with the mistakenly-assumed rejection suppressed Damon’s immune system. They reduced his ability to fight off the infection and he died. The author of the book, Damon’s father, sued the doctors and hospital for malpractice. The doctors did not exactly “ignore” the immune system, but they apparently failed to fully grasp the danger of immune suppression, even though the infection that killed Damon is common in transplant cases. (Although Columbia Presbyterian charged half a million dollars for the transplant, “three years into the lawsuit the [hospital’s] medical director claimed Damon’s post-op records couldn’t be located.”)

3. I asked a UCSF medical student what she’d been taught about the immune system. “We cover it!” she said. In a section called “Infectious Disease, Immunology, and Inflammation”. What makes the immune system work better or worse? I asked. “If you’re stressed out, it doesn’t work well,” she said. If you’re malnourished, like in Bangladesh. You need “nutrients and vitamins”. (A booklet I got telling me to take less antibiotics told me to “eat healthy”.) She also said the students get entire lectures on how to treat diseases so rare they might never be encountered. There is a whole section on genetics. Sure, they cover it. So superficially that they don’t remember the most basic idea: Better sleep –> better immune function. I said our health care system is built around first, let them get sick. That’s right, she said. Ignoring the immune system is an excellent way to allow people to get sick.

4. Melissa McEwen pointed out that proton pump inhibitors, such as Nexium, reduce the body’s ability to fight infection. They are prescribed for acid reflux and reduce how much acid the stomach makes. Because stomach acid kills bacteria, there should have been far more concern about their safety. “Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide [billions of prescriptions]. . . . The collective body of information overwhelmingly suggests an increased risk of infectious complications,” says this article. Because the drugs are so common, the damage is great and, because of more infection, not restricted to those who take them. It could have been avoided by research into treatments that do not harm the immune system.

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on Monday, June 11th, 2012 at 5:00 am and is filed under health care, ignorance, immune system, sleep.
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I think there are too many confounding factors in the cold wet feet study to give it much credence. Number one on the list is exposure to the virus – past or present – dormant or active.

A better test, but by no means conclusive, would be to set up the test as they did and then expose everyone to the virus. Then see who comes down with a cold and who doesn’t. Still too many confounders though.

I commented on your last post on vitamin D how I haven’t had any colds since I’ve been taking 5k IUs and getting plenty of sun exposure. I also stopped taking Prilosec (a proton pump inhibitor) at about the same time. Interesting.

Let’s be clear, there is no such thing as an Immune System in the human body. There are eleven systems in the body and not one of them is called the Immune System. The body has the Lymphatic System which includes organs that develop cells devoted to immunity. Geez I learned this the first week of Anatomy and Physiology, you would think a doctor would know better.

Thank you so much for educating us. While you are at it, you should send a blistering letter off to the Mayo Clinic, because they have a web page titled, ‘Your Immune System.’

Also send a nasty snarky letter of correction to WebMD, because they have a web page with the subtitle, ‘Using Your Immune System to Stay Well’.

And be sure to lecture the Cleveland Clinic, given that they have a web page saying, ‘The human body has a highly efficient immune system, providing multiple defenses to ward off invaders such as bacteria, viruses and harmful chemicals.’

My point was directed at a medical professional not you, but since you have responded I shall make this comment just for you.

There is no such thing as an Immune System. Cells/tissues of the Lymphatic System make up immunity. If you look at an actual college level Anatomy and Physiology textbook you will be able to read that there is no such thing as an Immune System. There are eleven systems in the body, not twelve. Maybe someday they will subdivide the Lymphatic System into two systems, but that is not how it is today.

Suggestion for you – maybe you should consider getting your information from actual fact based text books instead of web pages? Just saying…

Seth, here’s an example of the widespread belief that suppressing the immune system is harmless. The immune system is involved in the local inflammatory response post-injury. One might imagine that this has something to do with the healing process (though I have no idea what the medical textbooks say about this).

It has been known for many years that non-steroidal anti-inflammatory drugs, which suppress inflammation, may also impair healing, particularly of bone and cartilege (see e.g. http://www.ncbi.nlm.nih.gov/pubmed/15177303 from 8 years ago). Many years later, human data on this subject is still lacking (see http://www.ncbi.nlm.nih.gov/pubmed/20487623), while perscription of NSAIDs apparently remains standard of care for orthopedic injuries. My friend was recently perscribed one for a sprain, and I asked a doctor I knew why. He agreed that they could slow the healing process, and that they were only perscribed for pain relief (my friend had no pain, and was not given this information by the perscribing doctor).

I still do not understand why using ‘immune system’ is inappropriate. A search of PubMed for titles which include ‘immune system yields 6815 titles. I briefly browsed several papers to learn the authors worked in departments such as Medicine and Immunology.

Seth, it would be interesting if you could use your contacts to find a competent Traditional Chinese Medicine physician to interview about whether that system considers it important to improve the immune system.

Seth: Good idea. I think a lot of Traditional Chinese Medicine herbs do just that — stimulate the immune system. But what about prevention?

It seems to me that our problem is not a weakened immune system, but rather an overactive immune system. there is an epidemic of autoimmune diseases happening, whether it is type 1 diabetes, multiple sclerosis, eczema or lupus. my recent experiences demonstrate this.

my daughter was recently diagnosed with type 1 diabetes mellitus (T1DM). T1DM is a disease in which the body’s immune system attacks the insulin-producing cells in the pancreas. the endocrinologist who diagnosed my daughter said that there is a big increase in T1DM, especially in the northern latitudes. He posited that it may be due to lack of sunlight, much like MS.

I suffer from eczema, which is also on the increase and is also an autoimmune disorder.

1. Yes better sleep does seem to lead to better immune function. Good thing no one in the medical community studies that. Oh wait, http://www.ncbi.nlm.nih.gov/pubmed/21835655
Also, hospitals don’t wake patients up solely to disturb their sleep, usually it is to get rounding/pre-rounding out of the way so the doctors can see and treat more patients. If you ran a hospital where you could never disturb the patients, you would get very little done.

2. That is a tragic story. However, if it was transplant rejection, and immunosuppressive therapy wasn’t initiated there would have been a guaranteed organ rejection and death. That’s the thing about medicine, you actually have to make hard choices with real consequences. Transplant rejection and an infection can manifest very similarly, and the life of your patient hangs in the balance. Then you have to own up to your mistakes. Very much unlike watching from the stands and having 20/20 hindsight as you criticize from a blog. Its not like they gave immunosuppressive therapy for no reason. They knew it had risks.

3. Thanks for that anecdote from talking to one medical student. Did you by chance ask her if sleep deprivation effected the immune system, or just listen to her list variables from a course she took and see if she missed your favorite variable sleep? I would bet that if you directly asked her about sleep deprivation, she would have told you it was not good for the immune system. Either way, one medical student at one medical school is hardly damning evidence. My friend, who will be a medical student next year, knew that before taking a course on the immune system. Of course her evil medical education will probably beat that knowledge out of her and teach her how to give advice that makes people sicker (/sarcasm).

4. Please, less citing of blogs and more citing of studies. Oh and btw, the study you did cite said this “PPIs have REVOLUTIONIZED the management and complications of acid-related disorders with a HIGH MARGIN OF SAFETY; however, with the data available, efforts to reduce the dosing of or discontinue the use of PPIs must be reassessed frequently.” (emphasis mine)

It does not call for the end of PPIs, only that they be used responsibly in the treatment of acid related disorders with this new data in mind. But hey, you do a great job of quoting out of context.
Oh would you look at that, evidence based medicine changing practices to improve patient care! But I thought the doctors didn’t care about making people better!

Seth: What does “HIGH MARGIN OF SAFETY” mean? I have no idea. “High margin” compared to what?

It would be even more interesting if the TCM practitioners actually had data showing their treatments could increase immune function.

Also, competent TCM Doctor is a bit of an oxymoron when there is no evidence supporting TCM being, oh I don’t know, effective against disease.

Seth: You appear unaware of evidence that the immune system is effective against disease (“you have no evidence that if our immune systems were much stronger, we would need to use antibiotics much less”).

“A 2011 Cochrane review documented that acupuncture is effective in the treatment of migraines, neck disorders, tension headaches, and some types of osteoarthritis …”

There’s also a little drug called 青蒿素 (Artemisinin) from TCM that is the most effective known medicine for treatment of Malaria and the worldwide standard. The discoverer is being considered for a Nobel prize.

By ‘competent TCM physician’ I mean the following: ask for a referral from a trusted colleague. Seth works/lives in both the Bay Area and Beijing. He knows intelligent and skeptical colleagues who have had various medical issues. I think it possible that one or more of them would have received useful treatment from a TCM physician, most likely after failing to find relief from allopathic medicine.

If you ask a TCM physician about prevention steps to improve the immune system, I suspect you will hear about food therapy, supplements, Qigong, acupuncture, and meditation. You may also hear about unfamiliar concepts such as Yin or Yang deficiency (and many more). I am slogging through a book about Chinese healing, but the concepts are so foreign that not much is making sense.

I have never been to a TCM physician so I have no idea what you might hear.

I have an economic perspective on whether TCM is valid, in that those medical technologies which do not succeed at treating problems eventually fade away due to lack of customers. TCM appears to be practiced in the Bay Area and is thriving in China.